HomeMy WebLinkAbout34-2110-011-1400FINAL ELEVATION CERTIFICATE
This certificate shall be submitted for compliance of lIc3-3f to DERM Flood Plain Management Program to remove FINAL COMPLETION
HOLD
This certificate will not be accepted if all items are not completed
PROPERTY INFORMATION
(The following information to be provided by contractor, property owner or agent.)
Folio # 3 0 /(~c.Cy (NOT ACCEPTED WITHOUT FOLIO#)
Address 4 7 PROCESS #:4/7C50ermit A2z~;
New Construction 1/Addition, Reconstruction or combination
I certify that the above information represents my best effort to interpret the data required. I understand that any work undertaken prior to
obtain a certificate of completion or occupancy will be at the PERMIT HOLDER'S RISK. The County will review the elevation data
submitted. Deficiencies detected by such review shall be corrected by the permit holder immediately and prior to further progressive work
being permitted to proceed. Failuii-to submit the elevation survey or certificate or failure to make said corrections required hereby shall be
cause to issue a stop work order for he project.
Ll~ tv'e- Lol~,~ W~ l..wvs a-
Date:
Name: f
(print)
Phone #`~5`f 9gSo
(signature)
ELEVATION CERTIFICATE
This certificate is not valid if any items are altered or not completed.
Subdivision Name /yf 7Lot Blk PB S PG
Community #
Suffix
Panel #
Date of FIRM
FIRM Zone
Base Flood
120635
J
4~o
01 4
'7,07)"Ft. NGVD .
Using FEMA's Elevation Certificate instructions, indicate diagram found on Pages 5 and 6 that best describes the subject building's reference
level /
LOWEST FLOOR ELEVATION (Torence 1 ve el~...... 'FT. N . G . V . D .
r
LOWEST ADJACENT GRADE ELEVATION FT. N.G.V.D.
GARAGE OR STORAGE FLOOR ELEVATION IkIf~ - FT. N . G . V . D .
ELEVATION OF HIGHEST CROWN OF ROAD (Fronting Property) 25 ` FT. N. G. V. D.
A/C COMPRESSOR (Provide top elevation of supporting structure) FT. N . G . V . D .
I hereby certify that the information on this certificate is true and correct to the best of my knowledge and elief/.
Date Z Z222
C
Certifier's Name
Phone Ll J l "
Certifier's Signature
Certificate #
This form has been approved by The Federal Emergency Management Agency (FEMA) and may be used for flood insurance purposes-
Rev. May 31, 1995/ELEVCERT.195